Eosinophilic esophagitis
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Eosinophilic esophagitis is an allergic inflammatory condition of the esophagus. Symptoms are chest pain or heartburn and occasionally dysphagia, or difficulty in swallowing. The disease was first described in children but occurs in adults as well. The condition is not well understood, but it is thought that the intake of certain foods may play a role.
Diagnosis is obtained during an upper GI endoscopy where biopsies are taken of the esophagus. At the time of endoscopy, ridges or furrows may be seen in the esophagus wall. Sometimes, multiple rings (Schatzki rings may occur in the esophagus, leading to the term "multi-ring esophagus" or "feline esophagus" due to the similarity in the rings of the cat esophagus. A high number of eosinophils are seen on microscopic examination of the biopsy specimens. Skin testing can help identify which foods might contribute to this disease, but often skin testing implicates foods that are not involved. Common allergens in the GI tract are cow's milk, soy, egg and wheat.
Treatment strategies include removal of the offending food, proton pump inhibitors to decrease acidity in the stomach that may reflux into the esophagus, inhaled steroid puffers taken orally and swallowed, anti-histamines, H2-receptor blockers such as cimetidine, leukotriene modifiers such as montelukast, and, in investigational reports, the anti-IL5 monoclonal antibody mepolizumab. Refractory patients may require oral steroid medications.
Eosinophilic esophagitis (often referred to as EE in the United Sates, or EO in countries which use British spelling) was only discovered in recent years, and little is known about its pathogenesis. EE is a chronic disease associated with an elevated count of eosinophils in the esophagus. Normally, very few or no eosinophils are present in this upper digestive organ. In the past, patients with EE were incorrectly diagnosed as GERD suffererers. These patients were typically prescribed proton pump inhibitors, under the assumption that their problem was caused by excess stomach acid. However, researches have since discovered that EE patients often have a normal pH in their GI tract. The symptoms of GERD and EE are often similar, and this makes the diagnosis more difficult. But when a patient suffering from esophageal discomfort tests normal from a 24-hour pH probe, GERD is eliminated as a possible cause and EE becomes the main suspect. In fact, GERD patients may also show an elevated count of eosinophils, but this elevation is much lower than in EE patients.
At this time, the only reliable method used to diagnose EE is the upper endoscopy with multiple biopsies. The barium swallow test may show irregularities in the shape of the esophagus caused by EE, but not all patients have such physical characteristics. The endoscopy is performed by a gastroenterologist, a specialist in pathology associated with the GI tract. The upper endoscopy is normally done as an outpatient procedure, with the administration of mild anesthesia. Biopsy samples must be taken from multiple sites on the surface of the esophagus, to ensure that the condition is not overlooked.
More recently, researches have begun looking for links between EE and other autoimmune diseases. Some EE patients suffer from skin conditions such as psoriasis or seborrheic dermatitis or respiratory conditions such as asthma or allergic rhinitis. At this time, there appears to be no link between EE and esophogeal cancer.
Awareness of the disease is growing. In December 2007, EE received national attention after a Middleton, Idaho family, whose four children all suffer from the disease, were built a new home designed to manage its unique conditions by CBH Homes on the Emmy Award-winning TV show Extreme Makeover: Home Edition.
[edit] External links
- American Partnership for Eosinophilic Disorders
- Cincinnati Center for Eosinophilic Disorders
- UCLA Center for Esophageal Disorders
- CHOP Center for Pediatric Eosinophilic Disorders
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